Gerontological Nursing 8th Edition by Charlotte Eliopoulos – Test Bank

Complete Test Bank With Answers

 

 

Sample Questions Posted Below

 

CHAPTER 5

Nutrition and Aging

5.1•A nurse is discussing proper nutrition with clients at a senior citizen center. General guidelines for healthy elderly clients should include

increased amount of protein foods in the diet.

taking a geriatric vitamin or mineral supplement daily.

daily including at least 8 cups of fluids (excluding caffeinated and alcoholic beverages).

eliminating fat from the diet because of a decrease in physical activity.

Answer: 3

Rationale: Older persons are at risk for dehydration, and minimal daily needs are 1,500 ml or 8 cups of fluids. Caffeinated and alcoholic beverages have a diuretic effect and should not be included in the fluid intake. Current recommended dietary allowances (RDAs) for protein is 0.8 gm/kg body weight, the same for adult and older persons, so there is no recommended increase in protein intake. The best way to get vitamins and minerals is through a balanced diet, but a regular multivitamin is acceptable for elders who do not always eat healthy. Essential fatty acids are essential for life.ADVANCE \r 0 The source of caloric intake from fat should be 30% or less.

Implementation

Physiological Integrity

Application

5.2•A client who is taking prescribed medications for gastroesophageal reflux disease (GERD), including omeprazole (Prilosec), is at risk for altered absorption of which of these nutrients?

calcium and vitamin D

vitamin B₁₂ and vitamin D

potassium and iron

iron and vitamin B₁₂

Answer: 4

Rationale: Omeprazole is a proton-pump inhibitor medication prescribed to decrease the acidity in the stomach, especially in clients with GERD. Both iron and vitamin B₁₂ require an acidic environment to be adequately absorbed. Absorption of calcium, vitamin D, and potassium are not affected by the alkalinity of the stomach pH.

Diagnosis

Physiological Integrity

Analysis

5.3•Healthy adults often experience decreased strength and endurance in performing activities as they age.ADVANCE \r 0 This can be attributed to

an increase in cholecystokinin production.

a decrease in lean muscle mass.

lowered absorption of vitamin D.

depression.

Answer: 2

Rationale: Lean muscle mass diminishes with aging. ADVANCE \r 0The resultant loss of type II muscle fibers causes a decrease in function, including muscle strength and endurance. ADVANCE \r 0An increase in production of cholecystokinin occurs with aging, resulting in early satiety. Diminished vitamin D absorption, a normal occurrence of aging, ADVANCE \r 0leads to bone loss. Depression is not a normal part of the aging process.

Diagnosis

Physiological Integrity

Analysis

5.4•A nurse is in the process of discharging an older client with an open abdominal wound requiring dressing changes. ADVANCE \r 0The nurse has instructed the client about the importance of maintaining adequate hydration. ADVANCE \r 0Which statement by the client shows the need for further instruction?

“I can add an extra cup of decaffeinated coffee with breakfast and dinner.”

“I’ll drink water and nonsugared beverages whenever I feel thirsty.”

“I will set up a schedule to drink a glass of water every 2 hours throughout the day.”

“If I drink a lot of fluids, I’ll have to go to the bathroom more often, but I’ll get more exercise.”

Answer: 2

Rationale: ADVANCE \r 0The client needs additional instructions regarding adequate fluid intake. Because the thirst mechanism becomes blunted with age, the client cannot rely on feeling thirsty as a signal to meet hydration requirements. Use of a schedule to maintain adequate fluid intake is preferred because it provides the client with a continuous stimulus to take fluids. Decaffeinated fluids are allowed and will not lead to diuresis. ADVANCE \r 0The client can expect to urinate more often with the increased fluid intake.

Evaluation

Physiological Integrity

Analysis

5.5•Evaluate the following assessment data and select the datum that is suggestive of undernutrition.

body mass index (BMI) of 20.

serum albumin slightly below normal, prealbumin and transferrin within normal limits.

unintentional 3 pound weight loss over a month in a elderly woman weighing 120 pounds.

denial of taking a multiple vitamin supplement.

Answer: 1

Rationale:ADVANCE \r 0 A body mass index (BMI) less than 22 in the older person is predictive of undernutrition.ADVANCE \r 0 Albumin, prealbumin, and transferrin are plasma proteins. A lower serum albumin is less specific to malnutrition because it is affected by other conditions, such as liver disease, kidney conditions, and hydration status. Prealbumin and transferrin are more specific to current nutritional status. ADVANCE \r 0The 3 pound weight loss is 2.5% of the client’s body weight and is not diagnostic of undernutrition but needs continual close observation.ADVANCE \r 0 Taking a multiple vitamin supplement is not directly connected to a diagnosis of undernutrition.

Assessment

Physiological Integrity

Analysis

5.6•Which of the following older clients is at greatest risk for vitamin D deficiency?

the client who does not drink milk

the client who is taking isoniazid (INH) after a positive tuberculin skin test

the client who works outdoors daily and does not wear sunscreen

the client with macrocytic anemia

Answer: 1

Rationale: Milk in the United States is fortified with vitamin D, and clients who do not drink milk are at high risk for deficiency. Clients on isoniazid therapy are routinely prescribed vitamin B₆ (pyridoxine) to prevent a deficiency. ADVANCE \r 0Vitamin D is produced endogenously by the action of sunlight on the skin. Macrocytic anemia is associated with vitamin B₁₂ deficiency and is not associated with vitamin D deficiency risk.

Diagnosis

Physiological Integrity

Analysis

5.7•A resident in the nursing home is diagnosed with under nutrition and is unable to take in adequate food despite efforts by the multidisciplinary team and family members. Prior to insertion of a permanent feeding tube, what are the most important issues to be considered?

the extent of the surgical intervention, cost and insurance coverage

the client’s advanced directive and evaluation of risks, benefits, and ethical considerations

the client’s nutritional needs and tolerance of the formula feedings

equipment, care, and time needed to administer the feedings

Answer: 2

Rationale: Prior to placement of a permanent feeding tube, it is important to evaluate the individual client’s wishes and review the advanced directive. ADVANCE \r 0The client and family need accurate information regarding risks, benefits, and ethical considerations associated with placement of the feeding tube.ADVANCE \r 0 The actual placement of a feeding tube is a common, relatively simple procedure that can be performed as an outpatient. Costs of the equipment and formula are reimbursed by Medicare, Medicaid, or most insurance companies.ADVANCE \r 0 There are a variety of different formulas available for different client needs. Staff time may be reduced with the tube feeding than with actually feeding the client.

Safe, Effective Care Environment

Planning

Application

5.8•Which of the following observations made by the nurse is most suggestive that a client is having difficulty swallowing?

unintentional weight loss

cheilosis

drooling

long furrowed tongue

Answer: 3

Rationale: Drooling is a sign highly suggestive of difficulty swallowing because the client is unable to swallow the saliva produced in the mouth. Unintentional weight loss occurs with difficulty swallowing but is not a specific cause. Cheilosis is a condition where painful sores occur at the corners of the mouth sometimes associated with vitamin B₁₂ deficiency. Long furrows in the tongue are indicative of dehydration.

Assessment

Physiological Integrity

Analysis

5.9•The dietician at a long-term care facility has suggested diet supplementation for a client who continues to lose weight. Between-meal supplements ideally would be

peanut butter and crackers.

taken by the client more than an hour before the next meal.

foods served at room temperature.

not administered with medications.

Answer: 2

Rationale: Supplements should be given more than 1 hour before meals to minimize satiety and enable the client to still eat at mealtime. Liquid supplements are digested more quickly than solids thus decreasing the feeling of fullness. Temperature is not a significant issue. Liquid supplements may be given with medications as long as there is no interference with the specific medication.

Intervention

Physiological Integrity

Application

5.10•An elderly client has had a permanent feeding tube placed as a result of dysphagia. ADVANCE \r 0Which of the following nursing interventions will decrease the risk of aspiration?

flushing the tube with water before, between, and after each medication administered through the tube

administering formulas that contain fiber

keeping the head of the bed elevated at least 30Ε whenever the tube feeding is running by pump

the risk of aspiration no longer exists after a permanent feeding tube has been placed

Answer: 3

Rationale:ADVANCE \r 0 The head of the bed of clients receiving tube feeding should be elevated at least 30Ε to decrease the risk of aspiration. Flushing the tube with medications is necessary to prevent clogging of the tube. Formulas that contain fiber help stimulate normal bowel function. Clients with feeding tubes remain at risk for aspiration because the dysphagia still exists. High residuals in the stomach tube also put the client at risk for aspiration.

Intervention

Physiological Integrity

Application

5.11•Identify which of the following older clients receiving nutrition through a feeding tube is at the highest risk for dehydration.

receiving 50 ml free water at 4-hour intervals

receiving feeding with a formula that contains 1.5 calories per milliliter

receiving feedings by bolus method

with a jejunostomy tube

Answer: 2

Rationale: ADVANCE \r 0Tube feeding formulas that are denser than 1 calorie per milliliter are hypertonic and predispose the client to dehydration unless the client also receives free water. ADVANCE \r 0A client who is receiving 300 ml of free water daily would not be at risk for dehydration. Bolus feedings instead of continuous tube feedings may put the client at risk for aspiration but not for dehydration. The risk of dehydration is not associated with any particular site of a feeding tube.

Diagnosis

Physiological Integrity

Analysis

5.12•Which of the following persons are at highest risk for malnutrition as a result of hypermetabolism?

a client who has dysphagia

a client with osteoporosis

a client with chronic obstructive pulmonary disease

a client who is a vegetarian

Answer: 3

Rationale:ADVANCE \r 0 The client with chronic obstructive pulmonary disease often is malnourished because of the increased caloric need associated with breathing efforts. The client with dysphagia is at risk for malnutrition but because of the inability to eat adequate amounts of foods. Clients with osteoporosis do not have higher metabolic rates.ADVANCE \r 0 There is no connection between hypermetabolism and vegetarianism.

Diagnosis

Physiological Integrity

Analysis

5.13•A caregiver asks the nurse for suggestions to assist a cognitively impaired client to feed himself. ADVANCE \r 0The nurse should include which of the following instructions?

Place the food types in the same arrangement on the plate and relate the location to the face of a clock to assist the client in locating the food on the plate.

Offer the client a variety of favorite foods.

Provide diversional stimuli, such as a television show, so the client can eat without thinking about it.

Serve each food separately with the proper utensil and cue the client to use the utensil to eat that particular food.

Answer: 4

Rationale: Limiting the client to one task and food, and cueing the client to use the utensil to eat the specific food can be effective in promoting self-feeding. Placing the food on the plate and relating the location to a clock is used to assist clients with limited vision. Excess stimulation or offering the client many choices may add to the client’s confusion.

Intervention

Physiological Integrity

Application

5.14•Nutrients that are routinely considered for supplementation in the older adult are

the fat-soluble vitamins A, D, E, and K.

iron and folic acid.

calcium, vitamin D, and vitamin B₁₂.

zinc and vitamin C.

Answer: 3

Rationale: In healthy older adults only the vitamins D and B₁₂ and calcium are apt to be routinely supplemented. ADVANCE \r 0There is decreased absorption of vitamin B₁₂ in clients with altered gastric pH and atrophic gastritis.ADVANCE \r 0 Adequate intake requirements for calcium are increased in adults over age 50 because of accelerated bone loss and risk of osteoporosis. Adequate intake requirements for vitamin D are tripled for the older adult. ADVANCE \r 0Vitamin D is necessary for bone mineralization and utilization of calcium. ADVANCE \r 0The fat-soluble vitamins A, D, E, and K are stored in the body in adipose and other tissues. Supplementing with fat-soluble vitamins may put the client at risk for vitamin toxicity.ADVANCE \r 0 Iron, folic acid, zinc, and vitamin C are not usually deficient in healthy older adults and are not supplemented.

Intervention

Physiological Integrity

Knowledge

5.15•A nurse assessing an older client discovers that the client has become lethargic and confused over the past few hours. ADVANCE \r 0Which of the other observations made by the nurse during the assessment are consistent with a state of dehydration?

tenting on the forearm

temperature 98.8ΕF, orally

long tongue furrows

weight gain

Answer: 3

Rationale: Long furrows noted on the tongue are indicators of dehydration. Tenting on the forearm is not an accurate indicator of dehydration because the older client will often have tenting with a normal hydration status as a result of loss of skin elasticity. ADVANCE \r 0A temperature of 98.8ΕF is only slightly above normal. ADVANCE \r 0A low-grade fever sometimes occurs with dehydration.ADVANCE \r 0 A dehydrated client is expected to lose weight because of the loss of water within the body.

Assessment

Physiological Integrity

Application

5.16•Review the following data and select the information that is suggestive of undernutrition.

Body mass index (BMI) of 20

Serum albumin slightly below normal, prealbumin and transferring within normal limits

Unintentional 3-pound weight loss over a month in an elderly  woman weighing 120 pounds

Denial of taking a multiple vitamin supplement

Answer: 1

Rationale: A body mass index (BMI) less than 22 in the older person is predictive of undernutrition. Albumin, prealbumin, and transferring are plasma proteins. A lower serum albumin is less specific to malnutrition because it is affected by other conditions, such as liver disease, kidney condition, and hydration status. Prealbumin and transferring are more specific to current nutritional status. The 3-pound weight loss is 2.5% of the clients’ body weight and is not diagnostic of undernutrition but needs continual close observation. Taking a multiple vitamin supplement is not directly connected to a diagnosis of undernutrition.

Analysis; Physiological Integrity; Application

5.17•The nurse instructs a client with renal failure who is receiving hemodialysis about dietary modifications. The nurse determines that the client understands these dietary modifications if the client selects which items from the dietary menu?

Cream of wheat, blueberries, coffee

Sausage and eggs, banana, orange juice

Bacon, cantaloupe melon, orange juice

Cured pork, grits, strawberries, orange juice

Answer: 1

Rationale: The diet for a client with renal failure who is receiving hemodialysis should include controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3, and 4 are high in sodium, phosphorus, and potassium.

Analysis; Physiological Integrity; Evaluation

5.18•A client who recently has been started on enteral feedings begins to complain of 

abdominal cramping and has two liquid stools. A nurse notes that the client also has

abdominal distention. The nurse reviews the nutritional content on the label of the can of

feeding to determine if it has which of the following ingredients?

Lactose

Sucrose

Fructose

Maltose

Answer:  1

Rationale: Lactose intolerance can cause the symptoms that the client is reporting. Sucrose, fructose, and maltose are all potential ingredients in the feedings but are not associated with the abdominal cramping, distention, and diarrhea that the client is experiencing.

5.19•A nursing instructor is discussing dehydration risks in the older adult with a student

nurse. What response by the student indicates that the student needs further education?

“I will offer my client a drink of water every time I enter the client’s room.”

“I will administer my client’s furosemide (Lasix) with the evening meal.”

“I will administer my client’s furosemide (Lasix) with breakfast.”

“I will ensure that fresh water is available to my client.”

Answer: 2

Rationale: Dehydration risk factors in the elderly can include lack of free access to fluids and voluntary fluid restriction. By offering water to clients when entering their rooms and ensuring that fresh water is available, the risk for dehydration can be decreased. Administration of diuretics in the morning will help reduce the risk of dehydration when clients voluntarily restrict fluids and so experience nocturia.

5.20•A student nurse is preparing a presentation regarding the nutritional needs of the

older client. The nurse is basing the presentation on the Modified Food Guide Pyramid.

Which of the following need to be included?

3 servings of dairy per day

4 servings of dairy per day

3 servings of meat-poultry-fish-dry beans-eggs-nuts group

4 servings of meat-poultry-fish-dry beans-eggs-nuts group

Answer: 1

Rationale: The Modified Food Guide Pyramid suggests 3 servings of dairy per day and 2 servings of the meat-poultry-fish-dry beans-eggs-nut group.

Planning, Physiological Integrity, Comprehension

5.21•A nurse has been providing information to a client regarding the Modified Food

Guide Pyramid and caloric intake. What response by the client indicates understanding of

the education provided?

“If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 1,600 calories.

“If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 2,000 calories.

“If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 2,200 calories.

“If I consume the lowest daily recommended value for all of the food groups, it will result in approximately 2,400 calories.

Answer: 2

Rationale: By consuming the lowest daily recommended value for all of the food groups, it will result in approximately 1,600 calories.

Evaluation, Physiological Integrity, Analysis

5.22•A nursing has provided dietary instruction regarding vitamin D intake to an older

client. What response by the client would indicate a need for further instruction?

“I will eat liver at least once a week.”

“I will eat at least 3 servings of yogurt or cheese a day.”

“I will take a vitamin D supplement and eat 3 servings of dairy a day.”

“I am at greater risk for breaking my hip if I don’t have an adequate intake of vitamin D.”

Answer: 2

Rationale: Cheeses and yogurt are not mandated to be fortified with vitamin D and should not be considered good sources of vitamin D. Food sources of vitamin D include liver, fish liver oils, and fortified milk. Vitamin D is required for its role in maintaining bone mineralization and proper serum calcium level. Low levels of vitamin D can lead to bone loss and increased risk of fractures.

Evaluation, Physiological Integrity, Application

5.23•A student nurse is preparing a presentation regarding nutritional issues in the older

client. Which of the following statements would the student need to include in the

presentation?

“White older persons are at a higher risk for food insecurity than African Americans.”

“African American older persons are at a higher risk for food insecurity than Caucasian  Americans.”

“Food insecurity is when a person is fearful that he or she will not have enough food to eat.”

“Food insecurity is when a person is concerned that he or she is eating foods that might be harmful to his or her health.”

Answer: 2

Rationale: Food insecurity is when a client lacks sufficient funds or access to buy food. It can force an individual to decide between paying bills, buying medications or buying groceries. African Americans and Hispanic older persons are at a disproportionate risk of food insecurity compared with older Caucasian persons. 

Planning, Physiologic Integrity, Application

5.24•A long-term care nurse is preparing an educational program for her peers on

malnutrition. Which of the following criteria should the nurse include as risk factors for

malnutrition? Select all that apply.

Chewing problems

Mouth pain

Weight loss of greater than 3% in 1 month

Altered taste

Tube feeding

Answer: 1, 2, 4, 5

Rationale: Pertinent risk factors for malnutrition from MDS criteria include chewing problems, mouth pain, altered taste, presence of tube feeding, and weight loss of greater than 5% in 1 month.

Planning, Physiologic Integrity, Application

5.25•A home health nurse is speaking to the daughter of a client who has had an

unintentional weight loss of 20 pounds in the last 3 months. The client resides with her

daughter. The daughter asks the nurse “what can I do to help keep my mom from losing

more weight?” Which is the most appropriate response by the nurse?

“You can add nonfat milk powder to food such as scrambled eggs to add more protein.”

“There is not much you can change. Weight loss is just part of the aging process.”

“Give your mother her liquid nutritional supplements with her meals.”

“If she smoked in the past, let her start smoking again. This may increase her appetite.”

Answer: 1

Rationale: Interventions for clients with undernutrition issues include adding nonfat milk to soups, puddings, scrambled eggs, and other recipes. Offer nutritional supplements at least an hour before or after a meal. Encourage the client to stop smoking to help improve taste perception. Weight loss is not a part of the normal aging process.

25. A nurse is preparing a care plan for a client in a long-term care facility who is experiencing dysphagia. Which of the following would be the priority nursing diagnosis for this client?

Imbalanced nutrition: more than body requirements related to assisted feedings

Imbalanced nutrition: less than body requirements related to inability to swallow foods and liquids

Deficient knowledge related to need for thickened liquids

Noncompliance related to need for thickened liquids

Answer: 2

Rationale: Imbalanced nutrition: less than body requirements would be the priority nursing diagnosis for this client. Deficient knowledge and noncompliance may be appropriate for this client if he or she does not understand or correctly follow the special diet that may be ordered. Assisted feedings are associated with imbalanced nutrition: less than body requirements, not more than body requirements.

Diagnosis; Physiological Integrity; Application